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NORTHWEST NETBALL

COURSE BOOKING FORM

Please complete ALL information on this booking form:

Course Name: / Beginners Umpiring course. Ref: 1577
Venue: / Solway Community Technology College, Silloth, Cumbria. CA7 4DD
Date: / 21st November 2015 (10am – 2pm)
Candidate Name (Ms/Mr/Miss/Mrs):
Candidate Address:
Contact Telephone No Mobile:
E-mail address:This is used to confirm place^
Date of Birth:
Affiliation No:**Must be affiliated to attend an umpiring course. Please fill in the name of the Club you affiliate through and /or County / Club or County affiliated to:
Emergency Contact Name & telephone Number:
Medical Information
(e.g epilepsy, asthma, diabetes, allergies etc)

Please list below any Netball / Umpiring related experiencee.g. Umpire at club level / school, umpiring courses attended:

Are you able to ask a couple of players to come for last couple of hours

to play games?(Whilst you umpire) Yes ⃞ No ⃞

Are you able to actively take part in the game of Netball? Yes ⃞ No ⃞

In case we do not have enough players. If no, please detail the reason:

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Would you like to receive information about future netball courses/workshops? Yes ⃞ No ⃞

Payment: £30 – Beginners -By Cheque made payable to North West Netball

Please ensure you enclose full payment. Cheques must be with the candidates name clearly printed on the back please send to:

NW Netball Courses; National Cycling Centre, Stuart Street, Manchester, M11 4DQ

Due to high demand, we are unable to reserve places,without paymentcompleted form.

If the course becomes fully booked, we will compile a waiting list. (Cheques are banked after the course has ran)

Forms can be emailed to . ^Final email and course information will be emailed to all candidates in the week before the course date from this email address.

Cancellation Policy:

Requests to cancel / transfer a booking should be directed to your Course Organiser and will be considered on an individual basis.

Date booking form received: Place confirmed Course confirmed

Payment received: Y / N Amount £Cheque No Name on Chq